Folded buttress for use with a surgical apparatus

ABSTRACT

An end effector for use with a surgical apparatus. The end effector comprising a staple cartridge having a tissue contacting surface defining a central longitudinal slot and an anvil plate having a tissue contacting surface defining a central longitudinal slot. A folded surgical buttress configured to overlie each of the tissue contacting surfaces of the staple cartridge and anvil plate and configured to retain the surgical buttress to the tissue contacting surfaces of each of the staple cartridge and anvil plate. The surgical buttress having a first longitudinal portion, a second longitudinal portion, and middle longitudinal portion between the first and second longitudinal portions, wherein the middle longitudinal portion is folded and configured to fit within the central longitudinal slot of each of the staple cartridge and anvil plate.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical stapling apparatus includingsurgical buttresses which can be releasably attached to the surgicalstapling apparatus, and in particular, surgical buttresses folded andcontoured so as to remain securely attached.

2. Background of Related Art

Surgical stapling apparatus are employed by surgeons to sequentially orsimultaneously apply one or more rows of fasteners, e.g., staples ortwo-part fasteners, to body tissue for the purpose of joining segmentsof body tissue together. Such apparatus generally include a pair of jawsor finger-like structures between which the body tissue to be joined isplaced. When the stapling apparatus is actuated, or “fired”,longitudinally moving firing bars contact staple drive members in one ofthe jaws. The staple drive members push the surgical staples through thebody tissue and into an anvil in the opposite jaw which forms thestaples. If tissue is to be removed or separated, a knife blade can beprovided in the jaws of the apparatus to cut the tissue between thelines of staples.

It is known to rely on a knife blade for cutting off some portion of thesurgical buttress to affect release. A secondary material or mountingstructure may be employed in addition to the surgical buttress (e.g.,sutures) to provide attachment of the surgical buttress to the surgicalstapling apparatus. Typically, firing forces are increased with eachmaterial that must be transected by the knife blade in order to releasethe surgical buttress.

It would be desirable to provide a surgical buttress that may bereleasably secured to a surgical stapling apparatus without the need fora secondary material or mounting structure, and without the need for aknife blade to cut the secondary material or mounting structure torelease the surgical buttress from the surgical stapling apparatus,thereby resulting in the use of fewer materials and lower firing forces.It would also be desirable to provide a surgical buttress having greaterstructural integrity and rigidity without adversely effecting a firingsequence of the surgical stapling apparatus.

SUMMARY

According to one aspect of the present disclosure, an end effector foruse with a surgical apparatus wherein the end effector comprises astaple cartridge having a tissue contacting surface defining a centrallongitudinal slot and an anvil plate having a tissue contacting surfacedefining a central longitudinal slot. A folded surgical buttressconfigured to overlie each of the tissue contacting surfaces of thestaple cartridge and anvil plate and configured to retain the surgicalbuttress to the tissue contacting surfaces of each of the staplecartridge and anvil plate. The surgical buttress having a firstlongitudinal portion, a second longitudinal portion, and middlelongitudinal portion between the first and second longitudinal portions,wherein the middle longitudinal portion is folded and configured to fitwithin the central longitudinal slot of each of the staple cartridge andanvil plate. Preferably, the middle longitudinal portion issubstantially V-shaped.

In an alternate embodiment, the surgical buttress of the staplecartridge and anvil plate each define a bottom surface, and a proximalportion with a proximal edge, wherein the proximal portion is folded inthe direction of the bottom surface such that the proximal edge isadjacent the bottom surface of surgical buttress. The surgical buttressof the staple cartridge and anvil plate each have a distal portion witha distal edge, wherein the distal portion is folded in the direction ofthe bottom surface such that the distal edge is adjacent the bottomsurface of surgical buttress.

In another aspect of the present disclosure, a staple cartridge for usewith a surgical stapling apparatus, the staple cartridge comprising acartridge body including a tissue contacting surface defining aplurality of staple retaining slots and having a central longitudinalslot and a staple disposed within each staple retaining slot of thecartridge body. A folded surgical buttress is configured to overlie eachof the tissue contacting surfaces of the staple cartridge and anvilplate and configured to retain the surgical buttress to the tissuecontacting surfaces of each of the staple cartridge and anvil plate. Thesurgical buttress has a first longitudinal portion, a secondlongitudinal portion and middle longitudinal portion between the firstand second longitudinal portions, wherein the middle longitudinalportion is folded and configured to fit within the central longitudinalslot of each of the staple cartridge and anvil plate. Preferably, themiddle longitudinal portion is substantially V-shaped.

In an alternate embodiment, the surgical buttress of the staplecartridge defines a bottom surface, and includes a proximal portion witha proximal edge, wherein the proximal portion is folded in the directionof the bottom surface such that the proximal edge is adjacent the bottomsurface of surgical buttress. The surgical buttress of the staplecartridge further includes a distal portion with a distal edge, whereinthe distal portion is folded in the direction of the bottom surface suchthat the distal edge is adjacent the bottom surface of surgicalbuttress.

In another aspect of the present disclosure, a surgical staplingapparatus, comprising a housing and an end effector being secured to thehousing having a staple cartridge assembly having a tissue contactingsurface and an anvil assembly having a tissue contacting surface, eachof the staple cartridge assembly and anvil assembly having a centrallongitudinal slot. A folded surgical buttress is configured to overlieeach of the tissue contacting surfaces of the staple cartridge and anvilplate and configured to retain the surgical buttress to the tissuecontacting surfaces of each of the staple cartridge and anvil plate. Thesurgical buttress has a first longitudinal portion, a secondlongitudinal portion and middle longitudinal portion between the firstand second longitudinal portions, wherein the middle longitudinalportion is folded and configured to fit within the central longitudinalslot of each of the staple cartridge and anvil plate. Preferably, themiddle longitudinal portion is substantially V-shaped.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the presently disclosed interlocking buttressretention systems are disclosed herein with reference to the drawings,wherein:

FIG. 1 is a perspective view of a surgical stapling apparatus accordingto an embodiment of the present disclosure;

FIG. 2 is a perspective view, with parts separated, of a staplecartridge assembly of the surgical stapling apparatus of FIG. 1,illustrating an embodiment according to the present disclosure;

FIG. 3 is a perspective view, with parts separated, of an anvil assemblyof the surgical stapling apparatus of FIG. 1, illustrating an embodimentof the present disclosure;

FIG. 4A is a perspective view of an alternate embodiment of a surgicalbuttress according to the present disclosure;

FIG. 4B is a perspective view of another alternate embodiment of asurgical buttress according to the present disclosure;

FIG. 4C is a perspective view of yet another alternate embodiment of thesurgical buttress according to the present disclosure;

FIG. 4D is an enlarged area of detail depicted in FIG. 4B;

FIG. 4E is an enlarged area of detail depicted in FIG. 4C;

FIG. 5 is a perspective view of a distal end of the surgical staplingapparatus of FIG. 1, shown in use positioned about a tissue section;

FIG. 6 is a cross-sectional view taken along line 6-6 of FIG. 5; and

FIG. 7 is a perspective view of the stapled and divided tissue sectionof FIG. 5.

DETAILED DESCRIPTION OF THE EMBODIMENTS

Various exemplary embodiments of the present disclosure are discussedherein below in terms of surgical buttresses for use with surgicalstapling apparatus. The surgical buttresses described herein may be usedin sealing a wound by approximating the edges of wound tissue between astaple cartridge and an anvil plate of a surgical stapling apparatuswhich contains at least one surgical buttress. The at least one surgicalbuttress is releasably disposed onto a tissue contacting surface ofsurgical stapling apparatus by being configured to contour to the shapeof surgical stapling apparatus. This allows the surgical buttress toremain securely atop the tissue contacting surface without the need foradditional fasteners, sutures or similar structures. Firing of thesurgical stapling apparatus forces legs of at least one staple to passthrough an opening on the staple cartridge, the tissue, and the openingson the anvil plate to secure the surgical buttress to the tissue, tosecure the adjoining tissue to one another, and to seal the tissue. Thefiring force of the staple releases the surgical buttress from thetissue contacting surface. Thus, the present disclosure describessurgical buttresses, surgical stapling apparatus supporting saidsurgical buttresses, and methods and mechanisms for using the same.

It should be understood that a variety of surgical stapling apparatusmay be utilized with a surgical buttress of the present disclosure. Forexample, linear stapler configurations may be utilized, such as, forexample staplers with Tri-Staple Technology™, available throughCovidien, which maintain a principal place of business at 555 Long WharfDrive, North Haven, Conn. 06511, and transverse anastomosis staplers,such as, for example, EEA™, CEEA™, GIA™, EndoGIA™, and TA™ staplers,also available through Covidien. It should also be appreciated that theprinciples of the present disclosure are equally applicable to surgicalstaplers having alternate configurations, such as, for example,end-to-end anastomosis staplers having a circular cartridge and anvil(see, e.g., commonly owned U.S. Pat. No. 5,915,616, entitled “SurgicalFastener Applying Apparatus,” the entire content of which isincorporated herein by this reference); laparoscopic staplers (see,e.g., commonly owned U.S. Pat. Nos. 6,330,965 and 6,241,139, eachentitled “Surgical Stapling Apparatus,” the entire contents of each ofwhich being incorporated herein by this reference); and transverseanastomosis staplers (see, e.g., commonly owned U.S. Pat. Nos. 5,964,394and 7,334,717, each entitled “Surgical Fastener Applying Apparatus”, theentire contents of each of which being incorporated herein by thisreference).

Embodiments of the presently disclosed surgical buttress and surgicalstapling apparatus will now be described in detail with reference to thedrawing figures wherein like reference numerals identify similar oridentical elements. In the following discussion, the terms “proximal”and “trailing” may be employed interchangeably, and should be understoodas referring to the portion of a structure that is closer to a clinicianduring proper use. The terms “distal” and “leading” may also be employedinterchangeably, and should be understood as referring to the portion ofa structure that is further from the clinician during proper use. Asused herein, the term “patient” should be understood as referring to ahuman subject or other animal, and the term “clinician” should beunderstood as referring to a doctor, nurse, or other care provider andmay include support personnel.

Referring now to FIG. 1, there is disclosed an exemplary surgicalstapling apparatus or surgical stapler 10 for use in stapling tissue andapplying a buttress material or surgical buttress to the tissue. Anexample of this type of surgical stapling instrument is disclosed inU.S. Pat. No. 7,128,253, the entire disclosure of which is incorporatedby reference herein.

Surgical stapling apparatus 10 generally includes a handle 12 having anelongate tubular member 14 extending distally from handle 12. An endeffector assembly 16 is mounted on a distal end 18 of elongate tubularmember 14. End effector assembly 16 includes a first jaw or staplecartridge assembly 200 configured to receive a staple cartridge 32therein and a second jaw or anvil assembly 300. End effector assembly 16may be permanently affixed to elongate tubular member 14 or may bedetachable and thus replaceable with a new end effector assembly 16. Inaddition to a replaceable end effector assembly or as an alternativethereto, the cartridge assembly 200 can be removable and replaceable.One of staple cartridge assembly 200 and anvil assembly 300 is movablymounted at distal end 18 of end effector assembly 16, and is movablebetween an open position spaced apart from one another to a closedposition substantially adjacent to one another. Anvil assembly 300supports an anvil plate 302 and may be fabricated from a metal material,including and not limited to stainless steel, titanium, titanium alloy,and the like. The tissue contacting surface of staple cartridge 32 maybe fabricated from a material other than metal, including and notlimited to plastic, thermoplastic, resin, polycarbonate, and the like.

Surgical stapling apparatus 10 further includes a trigger 33, as seen inFIG. 1, movably mounted on handle 12. Actuation of trigger 33 initiallyoperates to move first jaw and second jaw between the open and theclosed positions and simultaneously actuates surgical stapling apparatus10 to apply lines of staples to tissue. In order to properly orient endeffector assembly 16 relative to the tissue to be stapled, surgicalstapling apparatus 10 is additionally provided with a rotation knob 34mounted on handle 12. Rotation of rotation knob 34 relative to handle 12rotates elongate tubular member 14 and end effector assembly 16 relativeto handle 12 so as to properly orient end effector assembly 16 relativeto the tissue to be stapled.

A driver 36, as seen in FIGS. 5 and 6, is provided to move approximatefirst jaw or staple cartridge assembly 200 and second jaw or anvilassembly 300 from the open position to the closed position. Driver 36moves through a central longitudinal slot 338 (FIG. 3) formed in theanvil plate 302 of anvil assembly 300. A knife 30 with knife blade 31 isassociated with driver 36 to cut tissue captured between staplecartridge assembly 200 and anvil assembly 300 as driver 36 passesthrough slot 338.

Reference may be made to commonly owned U.S. Pat. Nos. 5,915,616,6,330,965, and 6,241,139, the disclosures of each of which are herebyincorporated by reference in their entirety, for a detailed discussionof the construction and operation of an exemplary surgical staplingapparatus 10.

Staple cartridge assembly 200 and/or anvil assembly 300 may be providedwith a surgical buttress 500. Surgical buttress 500 is provided toreinforce and seal the lines of staples applied to tissue by surgicalstapling apparatus 10. Surgical buttress 500 may be configured into anyshape, size, or dimension suitable to fit any surgical stapling,fastening, or firing apparatus.

Staple cartridge assembly 200 is provided with a cartridge buttress 500a and anvil assembly 300 is provided with an anvil buttress 500 b in themanners described in more detail hereinbelow. The buttresses 500 a, 500b may be made from any biocompatible natural or synthetic material. Thematerial from which the buttresses 500 a, 500 b are formed may bebioabsorbable or non-bioabsorbable. It should be understood that anycombination of natural (including animal derived materials), synthetic,bioabsorbable and non-bioabsorbable materials may be used to form thebuttress material. The buttresses 500 a, 500 b may be porous ornon-porous, combination of porous and non-porous layers. The non-porousbuttresses 500 a, 500 b may be utilized to retard or prevent tissueingrowth from surrounding tissues thereby acting as an adhesion barrierand preventing the formation of unwanted scar tissue. The buttressmaterial can be a film, foam, mesh, woven, non-woven, or other material,and can be formed by molding, blown film processes, melt blown and/orspun bonding processes.

Additional exemplary materials for surgical buttresses 500 a, 500 b foruse with the surgical stapling devices disclosed herein are set forth incommonly assigned U.S. Pat. Nos. 5,542,594; 5,908,427; 5,964,774; and6,045,560, and commonly assigned U.S. Application Publication Nos.2006/0085034, filed on Apr. 20, 2006; and 2006/0135992, filed on Jun.22, 2006, the entire contents of each of which is incorporated herein byreference. The buttress material may be formed as described in U.S.application Ser. No. 13/293,215, the entire disclosure of which ishereby incorporated by reference herein.

As illustrated in FIGS. 2 and 3, surgical buttress 500 is releasablyattached to the inwardly facing or tissue contacting surfaces 220, 320of the staple cartridge 32 and/or the anvil plate 302. The surgicalbuttress 500 is folded and configured to contour to the shape of therespective staple cartridge 32 and anvil plate 302. Configuring thesurgical buttress 500 to take the shape of the staple cartridge 32 oranvil plate 302 allows the surgical buttress 500 to secure to therespective tissue contacting surfaces prior to firing of the staplingapparatus 10. The folded sections also provide stability for thebuttress while the instrument is used, and as tissue is grasped, theinstrument is manipulated, etc.

With reference to FIG. 2, cartridge buttress 500 a of staple cartridgeassembly 200 is operatively secured to a tissue contacting surface 220of staple cartridge 32. Cartridge buttress 500 a has a firstlongitudinal portion 510, a second longitudinal portion 512, and amiddle longitudinal portion 514 between the first and secondlongitudinal portions 510, 512. The middle longitudinal portion 514 isfolded and contoured to fit firmly within a central longitudinal slot238 of staple cartridge. In this embodiment, the first and secondlongitudinal portions 510, 512 remain atop the tissue contacting surface220 of staple cartridge. The middle longitudinal portion 514 issubstantially V-shaped or U-shaped such that a longitudinal gap existsalong the plane defined by the first and second longitudinal portions510, 512. Stated differently, cartridge buttress 500 a includes a firstcondition wherein cartridge buttress 500 a is substantially planar, anda second condition wherein the planar cartridge buttress 500 a is foldedalong its longitudinal axis to define a middle longitudinal portion 514that is substantially V-shaped, so as to define a central longitudinallyextending tab or fin. The buttress could be molded in, or pressed into,this shape using heat and/or pressure.

Contouring the cartridge buttress 500 a to fit within the centrallongitudinal slot 238 prevents the cartridge buttress 500 a from lateralmovement during use of the stapling apparatus 10. Further, the exact fitof the middle portion 514 within the central longitudinal slot 238 ofthe staple cartridge 32 provides friction that firmly secures thecartridge buttress 500 a in position. The shape of the fold or folds inthe buttress provides stability, and can be provided in the centralportion, distal portion, proximal portion, or lateral sides of thebuttress. As the knife blade 31 translates distally through centrallongitudinal slot 238, knife blade cuts the middle portion 514 of thecartridge buttress 500 a, along the folded portion, further releasingthe first and second longitudinal portions 510, 512 from the tissuecontacting surface 220 of staple cartridge 32.

FIGS. 2 and 3 illustrate additional features of the buttresses 500 a,500 b for securing the buttresses 500 a, 500 b to the respective tissuecontacting surfaces 220, 320. As shown in FIG. 2, staple cartridge 32has a first outer side surface 248 a and a second outer side surface 248b. A first extension 526 of the cartridge buttress 500 a extendsdownwardly from the first longitudinal portion 510. The first extension526 can be formed by a folded portion that extends towards the firstouter side surface 248 a of staple cartridge 32 and is positionedadjacent thereto. Similarly, a second extension 528 of the cartridgebuttress 500 a, which can also be a folded portion of the buttress,extends downwardly from the second longitudinal portion 512 and isfolded towards the second outer side surface 248 b of staple cartridge32 and positioned adjacent thereto. The first and second extensions 526,528 allow for increased strength to maintain the positioning of thecartridge buttress 500 a atop the tissue contacting surface 220 ofstaple cartridge 32. While the first and second extensions 526 and 528are shown in relation to the cartridge buttress 500 a, it is understoodthat the anvil buttress 500 b may include similar features.

With reference to FIG. 3, and similar to cartridge buttress 500 a, anvilbuttress 500 b is operatively secured to a tissue contacting surface 320of anvil plate 302 of anvil assembly 300. Anvil buttress 500 b is foldedand contoured such that the middle portion 514 is positioned firmlywithin the central longitudinal slot 338 of anvil plate 302. First andsecond longitudinal portions 510, 512 of anvil plate 302 remain atop thetissue contacting surface 320 of anvil plate 302. Stated differently,anvil buttress 500 b includes a first condition wherein anvil buttress500 b is substantially planar, and a second condition wherein the planaranvil buttress 500 b is folded along its longitudinal axis to define amiddle longitudinal portion 514 that is substantially V-shaped, so as todefine a central longitudinally extending tab or fin.

As shown in FIG. 3, first extension 526 extends from first longitudinalportion 510 and is folded towards a bottom surface 536 of the anvilbuttress 500 b. The first extension 526 is folded towards the bottomsurface 536 so as to lay adjacent the bottom surface 536 of firstlongitudinal portion 510 of anvil buttress 500 b. The second extension528 extending from second longitudinal portion 512 is folded towards thebottom surface 536 of second longitudinal portion 512 so as to layadjacent the bottom surface 536 of anvil buttress 500 b. This additionalfeature reinforces the anvil buttress 500 b and prevents the anvilbuttress 500 b from tearing during tensioning. Folded portions can beprovided at the lateral sides of the buttress to improve stability ofthe buttress on the cartridge and/or anvil members. While the first andsecond extensions 526 and 528 are shown in relation to the anvilbuttresses 500 b, in this embodiment, it is understood that thecartridge buttress 500 a may include similar features.

FIGS. 4A-4C illustrate alternate embodiments. Surgical buttress 500includes contouring corresponding to the shape of the staple cartridge32 and/or anvil plate 302. For description purposes only reference ismade to cartridge buttress 500 a and staple cartridge 32, however, it isunderstood that similar construction is utilized for anvil buttress 500b and anvil plate 302. In the alternative, the anvil buttress 500 b canbe configured differently, for providing stability and tear resistanceexperienced at the anvil plate 302.

In FIG. 4A, the middle longitudinal portion 514 of the surgical buttress500 a in this example is substantially planar and configured to lie atopthe tissue contacting surfaces 220 of the staple cartridge 32. In thisembodiment, first longitudinal portion 510 of the cartridge buttress 500a is folded towards the first outer side surface 248 a and is adjacentthereto. Similarly, second longitudinal portion 512 of the cartridgebuttress 500 a is folded towards the second outer side surface 248 b andis adjacent thereto. The coupling between the first longitudinal portion510 and the first outer side surface 280 a, and between the secondlongitudinal surface 512 and the second outer side surface 248 bprevents lateral movement of the cartridge buttress 500 a and anchorsthe cartridge buttress 500 a in position. Accordingly, the buttress 500a can have one or more longitudinal folded portions.

FIG. 4B illustrates another alternate embodiment, wherein cartridgebuttress 500 a defines a bottom surface 536, and cartridge buttress 500a includes a proximal portion 520 and a distal portion 522 that arefolded towards the bottom surface 536. Proximal portion 520 of cartridgebuttress 500 a has a proximal edge 530 that is folded towards the bottomsurface 536 so as to lay adjacent the bottom surface 536 of thecartridge buttress 500 a. Similarly, distal portion 522 of cartridgebuttress 500 a has a distal edge 532 that is folded towards the bottomsurface 536 so as to lay adjacent the bottom surface of the cartridgebuttress 500 a. The buttress has one or more folded ends. In thisembodiment, the proximal and distal portions 520, 522 are adjacent thetissue contacting surface 220 of staple cartridge 32. It is contemplatedthat the embodiments discussed herein for both the staple cartridge 32and anvil plate 302 can be used with well-known suture retention methodsknown in the art. For example, as shown in FIGS. 4B and 4D, a pair ofnotches 538 may be disposed within each of the folded regions of theproximal and distal portions 520, 522. The suture portion or portions,or some other kind of anchor, can be positioned in the notches.Alternatively or additionally, the buttress can be secured usingadhesives or welding.

FIG. 4C illustrates yet another alternate embodiment, wherein the firstand second longitudinal portions 510, 512 of cartridge buttress 500 aare folded towards the bottom surface 536 of the cartridge buttress 500a. In a similar manner as described above, a first longitudinal edge 540of first longitudinal portion 510 is folded towards the bottom surface536 so as to lay adjacent the bottom surface of cartridge buttress 500a. A second longitudinal edge 542 of second longitudinal portion 512 isfolded towards the bottom surface 536 so as to lay adjacent the bottomsurface 536 of cartridge buttress 500 a. In this embodiment, first andsecond longitudinal portions 510, 512 are adjacent the tissue contactingsurface 220 of staple cartridge 32. Notches 538, shown in FIG. 4E, aredisposed along the folded region. It is contemplated that the notches538 may be positioned in varying configurations to correlate with theuse of sutures well known in the art. The embodiments depicted in FIGS.4B and 4C reinforce the cartridge buttress 500 a and prevent thecartridge buttress 500 a from tearing during tensioning.

The notches 538 used for retaining sutures disclosed herein are setforth in commonly assigned U.S. Provisional Patent No. 61/696,906, filedon Sep. 5, 2012, the entire contents of each of which is incorporatedherein by reference.

Prior to assembly, the surgical buttresses 500 a, 500 b may be heatformed or cold folded into the contoured shape for receipt in therespective central longitudinal slots 238, 338 of staple cartridge 32and anvil plate 302. During assembly the surgical buttresses 500 a, 500b are placed onto each of the tissue contacting surfaces 220, 320 ofstaple cartridge assembly 200 and anvil assembly 300, respectively.Additional sutures or fasteners well known in the art may be used tofurther adhere the surgical buttresses 500 a, 500 b to each of thetissue contacting surfaces 220, 320. Additionally, other bonding methodssuch as adhesives, ultrasonic welding, laser welding, solvent bonding orheat pressing may be utilized in any of the embodiments disclosedherein.

As illustrated in FIG. 5, during use of surgical stapling apparatus 10,the first jaw or staple cartridge assembly 200 and the second jaw oranvil assembly 300, having surgical buttresses 500 a, 500 b loadedthereon (as described above) are positioned on either side of thesurgical site. Tissue contacting surfaces 220, 320 of staple cartridgeassembly 200 and anvil assembly 300 are positioned adjacent layers oftissue “T” to be fastened to one another.

As shown in FIG. 6, staple cartridge assembly 200 includes surgicalstaples 50 positioned within individual staple retaining slots 52 ofstaple cartridge 32. Staples 50 are of a conventional type and include abackspan 54 having a pair of legs 56 and 58 extending from backspan 54.Legs 56 and 58 terminate in tissue penetrating tips 60 and 62,respectively. Pushers 64 are located within staple retaining slots 52and are positioned between staples 50 and the path of a drive bar 66.

In the illustrated embodiment, surgical stapling apparatus 10 isinitially actuated by movement of trigger 33 relative to handle 12(FIG. 1) causing driver 36 to move in the direction of arrow “A” (FIG.5), and against sloped edge 21 of anvil plate 302 thereby causing anvilassembly 300 to be moved to the closed position relative to staplecartridge assembly 200. As drive bar 66 advances distally within staplecartridge 32, drive bar 66 urges pushers 64 upwardly against backspan 54of staples 50 driving legs 56 and 58 of staples 50 through the cartridgebuttresses 500 a, tissue “T”, and anvil buttress 500 b, towards stapleforming pockets 68 in anvil plate 302 of anvil assembly 300. Tissuepenetrating tips 60 and 62 of staple legs 56 and 58 are formed withinstaple forming pockets 68 in anvil plate 302 with backspan 54 securingsurgical buttress 500 against tissue “T”.

Upon full actuation of surgical stapling apparatus 10, a knife 30 (FIG.6) associated with surgical stapling apparatus 10 and carried by driver36 may be utilized to cut tissue “T”, as well as surgical buttresses 500a, 500 b between the rows of now formed staples 50. Upon movement ofanvil assembly 300 to the open position, spaced apart from staplecartridge assembly 200, buttresses 500 a, 500 b are pulled away andreleased from respective tissue contacting surfaces 220, 320 ofrespective staple cartridge assembly 200 and anvil assembly 300.

The resulting tissue “T”, divided and stapled closed with staples 50, isillustrated in FIG. 7. Specifically, surgical buttresses 500 a, 500 bare secured against tissue “T” by legs 56, 58 and backspan 54 of staples50. Thus, surgical buttresses 500 a, 500 b are stapled to tissue “T”thereby sealing and reinforcing the staple lines created by staples 50.

Persons skilled in the art will understand that the devices and methodsspecifically described herein and illustrated in the accompanyingfigures are non-limiting exemplary embodiments, and that thedescription, disclosure, and figures should be construed merelyexemplary of particular embodiments. It is to be understood, therefore,that the present disclosure is not limited to the precise embodimentsdescribed, and that various other changes and modifications may beeffected by one skilled in the art without departing from the scope orspirit of the disclosure. Additionally, it is envisioned that theelements and features illustrated or described in connection with oneexemplary embodiment may be combined with the elements and features ofanother exemplary embodiment without departing from the scope of thepresent disclosure, and that such modifications and variations are alsointended to be included within the scope of the present disclosure.Accordingly, the subject matter of the present disclosure is not to belimited by what has been particularly shown and described, except asindicated by the appended claims.

What is claimed is:
 1. An end effector for use with a surgicalapparatus, the end effector comprising: a staple cartridge having atissue contacting surface defining a central longitudinal slot; an anvilplate having a tissue contacting surface defining a central longitudinalslot; and a surgical buttress overlying and releasably retained on thetissue contacting surface of the staple cartridge or the anvil plate,the surgical buttress having a first longitudinal portion, a secondlongitudinal portion and middle longitudinal portion between the firstand second longitudinal portions, the surgical buttress and including aproximal portion with a proximal edge and a distal portion with a distaledge, wherein the middle longitudinal portion is folded and configuredto fit within the central longitudinal slot of the staple cartridge orthe anvil plate, and wherein at least one of the proximal portion or thedistal portion of the surgical buttress is folded against the bottomsurface of the surgical buttress, and positioned immediately adjacentthe bottom surface of the surgical buttress and the tissue contactingsurface of the staple cartridge or the anvil plate on which the surgicalbuttress is releasably retained.
 2. The end effector of claim 1, whereinthe middle longitudinal portion of the surgical buttress issubstantially V-shaped or U-shaped.
 3. A surgical stapling apparatus,comprising: a handle; an elongate tubular member extending distally fromthe handle; and a staple cartridge operably coupled to a distal end ofthe elongated tubular member, the staple cartridge comprising: acartridge body including a tissue contacting surface defining aplurality of staple retaining slots and having a central longitudinalslot; a staple disposed within each staple retaining slot of thecartridge body; and a surgical buttress overlying and releasablyretained on the tissue contacting surface of the staple cartridge, thesurgical buttress defining a bottom surface, and including a proximalportion with a proximal edge and a distal portion with a distal edge,wherein the proximal portion of the surgical buttress is folded againstthe bottom surface such that the proximal edge is immediately adjacentthe bottom surface of the surgical buttress, and wherein the distalportion of the surgical buttress is folded against the bottom surfacesuch that the distal edge is immediately adjacent the bottom surface ofthe surgical buttress and the tissue contacting surface of the staplecartridge.
 4. A surgical stapling apparatus, comprising: a handle; anelongate tubular member extending distally from the handle; an endeffector secured to a distal end of the elongate tubular member, the endeffector including a staple cartridge assembly having a tissuecontacting surface and an anvil assembly having a tissue contactingsurface, each of the staple cartridge assembly and anvil assembly havinga central longitudinal slot; and a surgical buttress overlying andreleasably retained on the tissue contacting surface of the staplecartridge or the anvil plate, the surgical buttress having a firstlongitudinal portion, a second longitudinal portion and middlelongitudinal portion between the first and second longitudinal portions,the surgical buttress defining a bottom surface, and including aproximal portion with a proximal edge and a distal portion with a distaledge, wherein the proximal portion of the surgical buttress is foldedagainst the bottom surface such that the proximal edge is immediatelyadjacent the bottom surface of the surgical buttress, and wherein thedistal portion of the surgical buttress is folded against the bottomsurface such that the distal edge is immediately adjacent the bottomsurface of the surgical buttress and the tissue contacting surface ofthe staple cartridge or the anvil plate on which the surgical buttressis releasably retained.